| NPI | 1184295438 |
|---|---|
| Former Name | BREANNA DAUGHERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 7919) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306604823) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-07-23 |